Anxiety is a common mental health disorder among most young adults between the age of 13 and 18 years. The National Institute of Health estimates that one out of every three teenagers will experience an anxiety disorder during this development period. The prevalence of the condition continues to increase, hence the need for establishing efficient treatment methods. The illness is challenging to diagnose and treat because of the complex symptoms that it presents. The symptoms, including sweating, rapid heartbeat, shortness of breath, chest pains, dizziness, and upset stomach, are also characteristic of other common physical diseases. Denizet-Lewis (2017) observed that teenagers are more prone to mental and emotional health disorders such as anxiety due to the rapid changes that the brain undergoes and the increased expectations as this population grows from childhood to adulthood. Treatment options for anxiety can be broadly categorized into pharmacological and nonpharmacological alternatives.
This EBP project proposal focuses on nonpharmacological treatment that does not involve the administration of drugs. The family-based therapy program or behavioral therapy program is an evidence-based intervention that effectively manages anxiety. Implementing this intervention among the teenagers who report stress will help determine the rate at which it reduces the condition’s symptoms within 12 months, compared to the pharmacological treatment. Implementing the project will be significant to teenage patients diagnosed with anxiety, mental health experts who handle these patients, their teenagers’ parents, and the overall healthcare system. The adolescent patients and their guardians will benefit from the project results because they will reveal an easily accessible treatment option. The mental health experts will benefit by gaining a conscientious problem-solving approach guided by current best practices.
Overview of the Problem
Mental health experts rank anxiety as one of the most common mental health issues among teenagers. Denizet-Lewis (2017) observed that anxiety is the most common mental-health disorder in the United States, affecting a third of both the adult and the teenage populations. Unfortunately, the healthcare system, patients, and their caregivers routinely undermine anxiety as a less serious medical problem than depression. Denizet-Lewis (2017) posited that it is easy to dismiss anxiety because everyone has it to some degree. Anxiety affects the normal functioning of a person and the quality of life differently. For some patients, the condition causes debilitating physical symptoms that compromise all aspects of their lives. The National Institute of Mental Health stipulates that 8.3% of adolescents diagnosed with anxiety disorder suffer from severe impairment and that more females experience the episodes than the male gender.
Anxiety affects the patients’ families’ quality of life in that the treatment options may prove expensive and inaccessible to a significant number of the patients. The condition also has substantial effects on the healthcare system. Overlooking anxiety has compromised the efforts of researchers and mental health experts to develop effective and current interventions against the mental condition. Centers for Disease Control and Prevention also highlighted the high prevalence of anxiety among children and adolescents in the United States. According to the CDC (2021), approximately 4.4 million children between the ages of 3 and 17 have been diagnosed with anxiety. The statistics could be higher, as a more significant number of patients remain undiagnosed. Although anxiety commonly co-occurs alongside other mental health problems like depression, ADHD, and other behavioral issues, considerable research evidence documents its effects on teenagers.
Apart from the physical symptoms, teenagers diagnosed with anxiety are also likely to experience poorer health outcomes than those who do not suffer from the condition. The American Academy of Child and Adolescent Psychiatry, AACAP, observed that teenagers who suffer from anxiety experience various physical symptoms like muscle cramps, headaches, stomachaches, limb pains, fatigue, and extreme pains associated with puberty changes. Teenagers suffering from anxiety may also miss vital life opportunities due to extensive shyness and fear of engaging in new activities (AACAP, 2021). Research evidence also shows that chronic and untreated anxiety is a precursor for serious mental health problems like drug abuse, severe depression, and eventual fatalities via suicide.
Management of anxiety is also an expensive endeavor for the patients and the healthcare sector. A randomized controlled trial involving 209 children revealed that the mean annual cost of treatment for the condition is approximately $6405 in direct costs and $4658 in indirect expenses for each patient (Pella et al., 2020). The prices increase with the severity of the condition and the complexity of the treatment options. Therefore, anxiety compromises the quality of life of the patients and their families, leads to higher medical costs, and undermines the healthcare sector’s efforts to enhance wellbeing and health across populations. The healthcare sector must establish an affordable and easily accessible treatment option for anxiety among the teenage population.
Project Purpose Statement
The purpose of the project is to investigate the effectiveness of family-based therapy or behavioral therapy as a treatment option against anxiety among teenagers within primary practice clinical settings. The efficacy of the intervention will be compared to pharmacological interventions that involve the prescription of drugs to such patients and the outcomes measured after 12 months. The expected results include decreased anxiety symptoms and better health outcomes among the patients.
Background and Significance
Research evidence has proven that anxiety is a severe mental condition that compromises patients’ quality of life and causes high medical expenses on families, individuals, and the healthcare system. The proposed intervention, family-based therapy, is unique in that it presents a novel approach to the treatment of the condition. The intervention involves the active engagement of parents in the intensive outpatient treatment program and replaces the traditional model of hospitalizing the patients under care (Le Grange et al., 2020). Also known as the Maudsley approach, the intervention integrates the positive role of the parents in their children’s recovery. Therefore, this approach considers the parent a vital resource in the treatment of the children. Unlike the cognitive-behavioral approach that emphasizes that the clinical problem belongs to an individual, FBT believes that the issues emanate and affect the whole family (Le Grange et al., 2020). Therefore, the Maudsley approach emphasizes treating the entire family to establish the etiology of a problem, treat it, and follow up to ensure that the patient recovers fully.
The proposed project will have various impacts on the anticipated results to better health and health outcomes. Anxiety disorder disproportionately affects teenagers because they are more predisposed to the condition. Research evidence shows that teenagers’ brain undergoes tremendous changes during this time, changing in shape and size. As a result, the brain connections and structures that control emotions and moods experience extreme changes, exposing teenagers to emotional and behavioral disorders like anxiety, stress, and depression. The heightened self-awareness further complicates the teenagers’ condition as they crossover from being children to young adults.
Therefore, the proposed project is expected to have a positive impact on the anticipated results. The target population is expected to experience fewer anxiety symptoms within 12 months than the control group receiving pharmacological interventions. The experiment will prove the efficacy of the FBT as an intervention against anxiety among teenagers and provide a valuable framework for mental healthcare experts. Although substantial research evidence shows that FBT effectively manages mental health disorders like depression and anxiety, there is a knowledge gap regarding its impacts on teenage anxiety.
PICOT-Formatted Clinical Project Question
In a group of patients between the ages of 13-18 with complaints of anxiety (P), implements a family-based therapy program or behavioral therapy program (I), compared to pharmacological interventions (C), resulting in a reported decrease in anxiety symptoms (O) within 12 weeks (T)?
Various key terms guided the search for evidence. These terms include anxiety disorder, anxiety disorder among teenagers, teenage anxiety, teenage anxiety treatment, treatment of anxiety in teenagers, family-based therapy against stress in teenagers, family-based therapy vs. cognitive behavioral therapy against fear, and family-based therapy vs. pharmacological treatment. The search was conducted on Google Scholar and various renowned medical databases, and it returned many results that demonstrate the capability of FBT to manage teenage anxiety effectively. The search produced many results, which were further filtered based on publication date and relevance to the topic. After elimination, the author selected five preliminary results for further analysis.
Denizet-Lewis (2017) found that factors such as family dynamics, societal expectations, and technological innovations like smartphones predispose teenagers to anxiety. The article also posited that over the last ten years, anxiety had overtaken depression as the reason why most college students seek counseling services. Although the report does not investigate the treatment options for the condition, it offers pertinent information regarding the importance of recognizing anxiety as a severe clinical problem across all populations. The authors recommend treatment options like art, exposure, and equine therapy to address the challenge of anxiety. The article does not explore FBT as a treatment option for anxiety, but it offers other nonpharmacological treatment options.
Le Grange et al. (2020) also investigated the role of CBT and FTB in managing eating disorders among teenagers using a nonrandomized trial. The trial compared the efficacy of FTB and CBT-E approaches in facilitating weight gain among the underweight participants. According to the authors, the study results showed that FTB achieved similar outcomes as CBT in promoting weight gain among underweight adolescents. Although the trial did not compare the efficacy of FTB and pharmacological treatments, it demonstrated the effectiveness of family-based therapy in managing behavioral conditions like eating disorders. The article provides essential background information for implementing the intervention in managing anxiety among the adolescent population.
Rudy et al. (2017) conducted a pilot study to examine the effectiveness of parent-led exposure therapy in managing behavioral anxiety among young children. The results revealed that well-adapted parent-led exposure programs are efficient in treating anxiety disorders among children. The authors recommended active coaching for the parents to enhance the efficacy of the program. While the article adopted exposure therapy as the treatment option, it incorporated FBT principles by actively engaging parents during the sessions. Although the study focused on young children between 4 and 7 years, it offers pertinent information regarding the implementation of FBT in treating anxiety in clinical settings.
Storch et al. (2019) also conducted a pilot study investigating the efficacy of family-based exposure therapy in managing autism spectrum disorder and anxiety among youths. Although the study primarily focused on autistic children with anxiety, it outlines a framework for implementing family-based treatment by showing how the intervention can be adjusted to fit different patient populations. The pilot study results showed that family-based exposure therapy was highly influential in managing anxiety among patients with autism.
Carr (2016) also investigated the application of family-based therapy on a range of adolescent mental and behavioral issues like anxiety, depression, and substance abuse. The study hypothesized that such strategies as Brief Strategic Family Therapy, Functional Family Therapy, Multisystemic Therapy, Multidimensional Family Therapy, and Multidimensional Treatment Foster Care effectively manage common adolescent disorders. These conditions include eating disorders, anxiety, depression, and drug abuse. FBT reduces individual and familial exposure to risk factors that predispose adolescents to disorders while enhancing coping mechanisms that empower the teenagers with coping skills against the diseases. The article provides pertinent background information regarding the optimization of FBT to fit various clinical needs.
Critical Appraisal of Literature
The above research provides essential information concerning the significance of FBT in managing anxiety among young children and adolescents. The studies also provide pertinent background information about applying the intervention and other alternative treatments against strain. Although the research articles offer sufficient evidence on the effectiveness of FBT in managing mental and behavioral disorders, there are evident knowledge gaps about the efficacy of the same compared to pharmacological treatments. For example, Carr (2016) only explored the various forms of FBT, while Storch et al. (2019) analyzed the efficacy of the FBT exposure therapy. However, I would utilize the results of these studies to inform the project proposal because of their strengths. The authors observe the rigor of research and use suitable data collection and analysis methods. Therefore, the results of the investigations are valid and reliable.
Develop an EBP Standard
Family-based therapy is a nonpharmacological intervention against anxiety that clinicians use to manage stress. Although the treatment is proven effective in treating the condition, it has not been extensively explored in managing anxiety among teenagers. I would recommend implementing Functional Family Therapy, FFT, and Multidimensional Family Therapy, MST, to address anxiety among teenagers (Sexton, 2017). FFT will involve engaging and motivating the family, encouraging behavioral change, and generalizing the results to the rest of the population. This approach is particularly essential to youths between eleven and eighteen years from different ethnic and cultural backgrounds (Sexton 2017). Therefore, it is easier to customize the intervention to accommodate other ethnic groups and ages. MFT is a comprehensive approach that centers on the whole family to treat mental and behavioral disorders such as anxiety. The method is essential for clients who may need out-of-home treatment due to underlying familial factors. Therefore, MFT ensures that the client receives therapy while under the care of the parents.
The proposed project has many potential contributions to nursing research, education, and practice expectations. The project charts a path for future research on the intervention’s efficiency across other patient populations. Future research may also focus on establishing how mental health experts can improve the efficacy of FBT by combining it with other evidence-based interventions like art and equine therapies. The proposal also contributes to the education system by expounding on the weaknesses and strengths of FBT in managing anxiety. Learners can compare its efficacy to other interventions, including pharmacological treatments. The proposal will also contribute to practice expectations by establishing EBP standards for treating anxiety among teenagers.
Carr, A. (2016). Family therapy for adolescents: A Research‐informed Perspective. Australian and New Zealand journal of family therapy, 37 (4) 467-479.
Centers for Disease Control and Prevention. (2021). Data and statistics on children’s mental health. Web.
Denizet-Lewis, B. (2017). Why are more American teenagers than ever suffering from severe anxiety. The New York Times Magazine, 11, 1-14
Le Grange, D., Eckhardt, S., Dalle Grave, R., Crosby, R. D., Peterson, C. B., Keery, H.,… & Martell, C. (2020). Enhanced cognitive-behavior therapy and family-based treatment for adolescents with an eating disorder: a non-randomized effectiveness trial. Psychological medicine, 1-11. Web.
National Institute of Mental Health. (2021). Any anxiety disorder. Web.
Pella, J. E., Slade, E. P., Pikulski, P. J., & Ginsburg, G. S. (2020). Pediatric anxiety disorders: a cost of illness analysis. Journal of Abnormal Child Psychology, 48 (4), 551-559. Web.
Rudy, B. M., Zavrou, S., Johnco, C., Storch, E. A., & Lewin, A. B. (2017). Parent-led exposure therapy: a pilot study of a brief behavioral treatment for anxiety in young children. Journal of Child and Family Studies, 26 (9), 2475-2484. Web.
Sexton, T. L. (2017). Functional family therapy. The Encyclopedia of Juvenile Delinquency and Justice, 1-7.
Storch, E. A., Schneider, S. C., De Nadai, A. S., Selles, R. R., McBride, N. M., Grebe, S. C.,… & Lewin, A. B. (2019). A pilot study of family-based exposure-focused treatment for youth with autism spectrum disorder and anxiety. Child Psychiatry & Human Development, 1-11. Web.